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Individual

MR. SUE ELLEN NESSLAGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
875 DUNSFORD DR, SULLIVAN, MO 63080-1238
(573) 468-3128
(573) 860-4646
Mailing address
3957 HIGHWAY T, CUBA, MO 65453-8177
(573) 437-5877

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
116273
MO

Other

Enumeration date
05/18/2007
Last updated
07/08/2007
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